Recall: A 9-month-old boy is brought to the clinic with a 2-day history of cough, wheezing, and difficulty feeding. His mother reports that he had a mild fever last night. On examination, his respiratory rate is 55/min, heart rate 140/min, oxygen saturation 92% in room air, and he has diffuse wheeze and fine crackles on auscultation.

Which of the following is the most appropriate next step in management? (Select one answer only)

A) Oral amoxicillin

B) Nebulised salbutamol

C) Intravenous fluids and supportive care

D) Oral corticosteroids

E) Chest physiotherapy

Answer:

C) Intravenous fluids and supportive care ✅

Explanation:

  • This presentation is most consistent with bronchiolitis (common in infants <1 year, often due to RSV).
  • Key management is supportive care: oxygen if hypoxic, hydration, and monitoring.
  • Salbutamol or corticosteroids are generally not recommended for routine bronchiolitis in infants <1 year.
  • Antibiotics are not indicated unless there is a secondary bacterial infection.
  • Chest physiotherapy is not helpful in bronchiolitis.
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